<style>
	div.enrollment-menu
	{
		padding:20px;
	}
	div.option{
		margin:20px 5px;
	}
	ul li{
		list-style:none;
	}
	textarea{
		width:90%;
		min-height:150px;
		max-height:150px
	}
	span{
		padding:0px;
		margin:0px;
		font-size:15px;
		color: #4d4d4d;
	}
	form.custom .custom.checkbox.checked:before {
    content: "\2714";
	cursor: pointer;
	}
	#legal_guardian_info{
		display:none;
	}
	#father_info{
		display:none;
	}
	#step_father_info{
		display:none;
	}
	#mother_info{
		display:none;
	}
	#step_mother_info{
		display:none;
	}
</style>

<div class="large-1 columns">&nbsp;</div>
<div class="large-10 columns enrollment-menu content-views">

<?echo form_open('enrollment/registration_form/'.$e_id,'id="check-form-submit" class="custom" data-abide autocomplete="off"');?>

<div class="alert">
	<i class="icon-info-sign"></i>&nbsp;&nbsp;<strong>Things To Remember</strong>
	<ul>
		<li><strong>Please use a valid email address as your account credentials will be sent there.</strong></li>
		<li><strong>Place "none", if you will answer none. For some required entry.</strong></li>
		<li><strong><?=form_checkbox('failure_to_provide', 'yes', TRUE);?>&nbsp;Failure to provide complete and accurate information of any kind on this form will void the application and may result to its cancellation. WESTFIELDS INTERNATIONAL SCHOOL reserves the right to determine the placement of the application in the grade level or subjects deemed most appropriate fo the student's school experience / performance.</strong></li>
		<li><strong><?=form_checkbox('to_the_best', 'yes', TRUE);?>&nbsp;To the best of my knowledge the information written on this form is true and correct.</strong></li>
	</ul>
</div>

<?=$system_message;?>

<div class="section-container auto" data-section>
  <section id="panel1" class="active">
    <p class="title" data-section-title><a href="#panel1">Step 1 <?php echo $error_number_1 > 0 ? '<span class="badge badge-important">'.$error_number_1.'</span>' : '<span class="label label-success">'.$error_number_1.'</span>' ; ?> </a></p>
    <div class="content" data-section-content>
      <p>
		<div class="clearfix"></div>
		<?php echo $this->load->view('enrollment/applicant_information'); ?>
	  </p>
    </div>
  </section>
  <section id="panel2">
    <p class="title" data-section-title><a href="#panel2">Step 2 <?php echo $error_number_2 > 0 ? '<span class="badge badge-important">'.$error_number_2.'</span>' : '<span class="label label-success">'.$error_number_2.'</span>' ; ?> </a></p>
    <div class="content" data-section-content>
      <p>
		<div class="clearfix"></div>
		<?php echo $this->load->view('enrollment/parent_legal_information'); ?>
	  </p>
    </div>
  </section>
  <section id="panel3">
    <p class="title" data-section-title><a href="#panel3">Step 3 <?php echo $error_number_3 > 0 ? '<span class="badge badge-important">'.$error_number_3.'</span>' : '<span class="label label-success">'.$error_number_3.'</span>' ; ?> </a></p>
    <div class="content" data-section-content>
      <p>	  
	  <div class="clearfix"></div>
	  <?php echo $this->load->view('enrollment/health_history_information'); ?>
	  </p>
    </div>
  </section>
  <section id="panel4">
    <p class="title" data-section-title><a href="#panel4">Step 4 <?php echo $error_number_4 > 0 ? '<span class="badge badge-important">'.$error_number_4.'</span>' : '<span class="label label-success">'.$error_number_4.'</span>' ; ?> </a></p>
    <div class="content" data-section-content>
      <p>
	  <div class="clearfix"></div>
	  <?php echo $this->load->view('enrollment/authorization_information'); ?>
	  </p>
    </div>
  </section>
</div>

<?php echo form_close(); ?>

</div>
<div class="large-1 columns">&nbsp;</div>
</div>

<?php
/*//// old form
$chooseAttrib = array('good' => 'good', 'fair' => 'fair', 'limited' => 'limited', 'none' => 'none' );
$genderAttrib = array('' => 'Select Gender...', 'male' => 'Male', 'female' => 'Female' );
$child_birth_position = array(''=>'-- Select --','first'=>'First','Second'=>'Second','third'=>'Third','fourth'=>'Fourth','fifth'=>'Fifth','sixth'=>'Sixth','youngest'=>'Youngest','only'=>'Only');
$citizAttrib = array('Filipino' => 'Filipino', 'Chinese' => 'Chinese', 'North Korean' => 'North Korean', 'South Korean' => 'South Korean', 'US Citizen' => 'US Citizen', 'other' => 'Other' );
$citizComp = array(
'Afghan' =>'Afghan',
'Albanian'=>'Albanian',
'Algerian'=>'Algerian',
'Andorran'=>'Andorran',
'Angolan'=>'Angolan',
'Argentinian'=>'Argentinian',
'Armenian'=>'Armenian',
'Australian'=>'Australian',
'Austrian'=>'Austrian',
'Bahamian'=>'Bahamian',
'Bahraini'=>'Bahraini',
'Bangladeshi'=>'Bangladeshi',
'Barbadian'=>'Barbadian',
'Belarusian,Belarusan'=>'Belarusian,Belarusan',
'Belgian'=>'Belgian',
'Belizean'=>'Belizean',
'Beninese'=>'Beninese',
'Bhutanese'=>'Bhutanese',
'Bolivian'=>'Bolivian',
'Bosnian'=>'Bosnian',
'Botswanan,Tswana'=>'Botswanan,Tswana',
'Brazilian'=>'Brazilian',
'British,Briton'=>'British,Briton',
'Bruneian'=>'Bruneian',
'Bulgarian'=>'Bulgarian',
'Burkinese'=>'Burkinese',
'Burmese'=>'Burmese',
'Burundian'=>'Burundian',
'Cambodian'=>'Cambodian',
'Cameroonian'=>'Cameroonian',
'Canadian'=>'Canadian',
'Cape Verdean'=>'Verdean',
'Chadian'=>'Chadian',
'Chilean'=>'Chilean',
'Colombian'=>'Colombian',
'Congolese'=>'Congolese',
'Costa Rican'=>'Costa Rican',
'Croat,Croatian'=>'Croat,Croatian',
'Cuban'=>'Cuban',
'Cypriot'=>'Cypriot',
'Czech'=>'Czech',
'Danish,Dane'=>'Danish,Dane',
'Djiboutian'=>'Djiboutian',
'Dominican'=>'Dominican',
'Dutch'=>'Dutch',
'Ecuadorean'=>'Ecuadorean',
'Egyptian'=>'Egyptian',
'Salvadorean'=>'Salvadorean',
'English'=>'English',
'Eritrean'=>'Eritrean',
'Estonian'=>'Estonian',
'Ethiopian'=>'Ethiopian',
'Fijian'=>'Fijian',
'Finn'=>'Finn',
'French'=>'French',
'Gabonese'=>'Gabonese',
'Gambian'=>'Gambian',
'Georgian'=>'Georgian',
'German'=>'German',
'Ghanaian'=>'Ghanaian',
'Greek'=>'Greek',
'Grenadian'=>'Grenadian',
'Guatemalan'=>'Guatemalan',
'Guinean'=>'Guinean',
'Guyanese'=>'Guyanese',
'Haitian'=>'Haitian',
'Honduran'=>'Honduran',
'Hungarian'=>'Hungarian',
'Icelander'=>'Icelander',
'Indian'=>'Indian',
'Indonesian'=>'Indonesian',
'Iranian'=>'Iranian',
'Iraqi'=>'Iraqi',
'Irish'=>'Irish',
'Italian'=>'Italian',
'Jamaican'=>'Jamaican',
'Japanese'=>'Japanese',
'Jordanian'=>'Jordanian',
'Kazakh'=>'Kazakh',
'Kenyan'=>'Kenyan',
'Kuwaiti'=>'Kuwaiti',
'Laotian'=>'Laotian',
'Latvian'=>'Latvian',
'Lebanese'=>'Lebanese',
'Liberian'=>'Liberian',
'Libyan'=>'Libyan',
'Liechtensteiner'=>'Liechtensteiner',
'Lithuanian'=>'Lithuanian',
'Luxembourger'=>'Luxembourger',
'Macedonian'=>'Macedonian',
'Malagasy,Madagascan'=>'Malagasy,Madagascan',
'Malawian'=>'Malawian',
'Malaysian'=>'Malaysian',
'Maldivian'=>'Maldivian',
'Malian'=>'Malian',
'Maltese'=>'Maltese',
'Mauritanian'=>'Mauritanian',
'Mauritian'=>'Mauritian',
'Mexican'=>'Mexican',
'Moldovan'=>'Moldovan',
'Monegasque,Monacan'=>'Monegasque,Monacan',
'Mongolian'=>'Mongolian',
'Montenegrin'=>'Montenegrin',
'Moroccan'=>'Moroccan',
'Mozambican'=>'Mozambican',
'Namibian'=>'Namibian',
'Nepalese'=>'Nepalese',
'New Zealander'=>'New Zealander',
'Nicaraguan'=>'Nicaraguan',
'Nigerien'=>'Nigerien',
'Nigerian'=>'Nigerian',
'Norwegian'=>'Norwegian',
'Omani'=>'Omani',
'Pakistani'=>'Pakistani',
'Panamanian'=>'Panamanian',
'Papua New Guinean,Guinean'=>'Papua New Guinean,Guinean',
'Paraguayan'=>'Paraguayan',
'Peruvian'=>'Peruvian',
'Pole'=>'Pole',
'Portuguese'=>'Portuguese',
'Qatari'=>'Qatari',
'Romanian'=>'Romanian',
'Russian'=>'Russian',
'Rwandan'=>'Rwandan',
'Saudi Arabian,Saudi'=>'Saudi Arabian,Saudi',
'Scot'=>'Scot',
'Senegalese'=>'Senegalese',
'Serb,Serbian'=>'Serb,Serbian',
'Seychellois'=>'Seychellois',
'Sierra Leonian'=>'Sierra Leonian',
'Singaporean'=>'Singaporean',
'Slovak'=>'Slovak',
'Slovene,Slovenian'=>'Slovene,Slovenian',
'Solomon Islander'=>'Solomon Islander',
'Somali'=>'Somali',
'South African'=>'South African',
'Spaniard'=>'Spaniard',
'Sri Lankan'=>'Sri Lankan',
'Sudanese'=>'Sudanese',
'Surinamer,Surinamese'=>'Surinamer,Surinamese',
'Swazi'=>'Swazi',
'Swedish,Swede'=>'Swedish,Swede',
'Swiss'=>'Swiss',
'Syrian'=>'Syrian',
'Taiwanese'=>'Taiwanese',
'Tajik/Tadjik'=>'Tajik/Tadjik',
'TaTanzanian'=>'TaTanzanian',
'Thai'=>'Thai',
'Togolese'=>'Togolese',
'Trinidadian'=>'Trinidadian',
'Tobagan/Tobagonian'=>'Tobagan/Tobagonian',
'Tunisian'=>'Tunisian',
'Turk'=>'Turk',
'Turkmen'=>'Turkmen',
'Tuvaluan'=>'Tuvaluan',
'Ugandan'=>'Ugandan',
'Ukrainian'=>'Ukrainian',
'Emirati'=>'Emirati',
'Uruguayan'=>'Uruguayan',
'Uzbek'=>'Uzbek',
'Vanuatuan'=>'Vanuatuan',
'Venezuelan'=>'Venezuelan',
'Vietnamese'=>'Vietnamese',
'a Welshman, a Welshwoman'=>'a Welshman, a Welshwoman',
'Western Samoan'=>'Western Samoan',
'Yemeni'=>'Yemeni',
'Yugoslav'=>'Yugoslav',
'Zairean'=>'Zairean',
'Zambian'=>'Zambian',
'Zimbabwean'=>'Zimbabwean'
);
?>
<div class="large-1 columns">&nbsp;</div>
<div class="large-10 columns enrollment-menu content-views">

<input type="button" value="Step 1: Applicant Information" class="btn btn-large btn-success" style="width:100%;">

<div>&nbsp;</div>

<?=$system_message;?>
<!--<div class="alert-box">REGISTRATION FORM Part 1: Student Personal Information And Family History</div>-->
<?echo form_open('register','id="check-form-submit" class="custom" data-abide autocomplete="off"');?>
<div class="alert">
	<i class="icon-info-sign"></i>&nbsp;&nbsp;<strong>Things To Remember</strong>
	<ul>
		<li><strong>Please use a valid email address as your account credentials will be sent there.</strong></li>
		<li><strong>Place "none", if you will answer none. For some required entry.</strong></li>
	</ul>
</div>

	<div class="large-12 columns"><h5 class="lead">APPLICANT INFORMATION (List all names as recorded in birth certificate/passport)</h5></div>
	
	<hr class="clearfix">
	
	<div class="large-4 columns">
		<span>Valid Email Address</span>
		<?='<br>'.form_error('email');?>
		<input type="email" data-tooltip class="has-tip tip-top" title="Student information, credentials and other news will be sent to your email address." name="email" value="<?=set_value('email');?>">
	</div>
	<div class="large-4 columns">
		<span>Grade Level</span>
		<?='<br>'.form_error('level_id');?>
		<?php echo form_dropdown('level_id', $levels, set_value('level_id'));?>
	</div>
	<div class="clearfix"></div>
	
	<div class="large-4 columns">
		<span>First Name</span>
		<?='<br>'.form_error('child_fname');?>
		<input type="text" name="child_fname" value="<?=set_value('child_fname');?>">
	</div>
	<div class="large-4 columns">
		<span>Middle Name</span>
		<?='<br>'.form_error('child_mname') == ''?'<span style="font-size:10px;font-weight:bold;">If No middle name just put "none"</span>':'<br>'.form_error('child_mname');?>
		<input type="text" name="child_mname" value="<?=set_value('child_mname');?>">
	</div>
	<div class="large-4 columns">
		<span>Last Name</span>
		<?='<br>'.form_error('child_lname');?>
		<input type="text" name="child_lname" value="<?=set_value('child_lname');?>">
	</div>
	<div class="large-4 columns">
		<span>Preferred Name</span>
		<?='<br>'.form_error('child_nickname');?>
		<input type="text" name="child_nickname" value="<?=set_value('child_nickname');?>">
	</div>
	<div class="large-4 columns">
		<span>Name Ext (e.g jr,II,III)</span>
		<?='<br>'.form_error('child_name_ext');?>
		<input type="text" name="child_name_ext" value="<?=set_value('child_name_ext');?>">
	</div>
	<div class="large-4 columns">
		<span>Gender</span>
		<?='<br>'.form_error('gender');?>
		<?=form_dropdown('gender', $genderAttrib, set_value('gender'));?>
	</div>
	<div class="clearfix"></div>
	<div class="large-4 columns">
		<span>Date of Birth:</span>
		<?='<br>'.form_error('child_bdate');?>
		<input type="text" name="child_bdate" class="birthdate" value="<?=set_value('child_bdate');?>">
	</div>
	<div class="large-4 columns">
		<span>Citizenship (Passport)</span>
		<?='<br>'.form_error('child_nationality');?>
		<?php echo form_dropdown('child_nationality', $citizAttrib, set_value('child_nationality'), 'id="child_nationality"');?>
	</div>
	<div class="large-4 columns">
		<span>Place of Birth</span>
		<?='<br>'.form_error('child_placeofbirth');?>
		<input type="text" name="child_placeofbirth" value="<?=set_value('child_placeofbirth');?>">
	</div>
	<div id="for_other_nationality" style="display:none;">
	<div class="clearfix"></div>
	<div class="large-4 columns"><span>&nbsp;</span></div>
	<div class="large-4 columns">
		<?php //echo form_dropdown('child_nationality2', $citizComp, set_value('child_nationality2'), 'id="child_nationality2"');?>
		<?='<br>'.form_error('child_nationality2');?>
		<input type="text" name="child_nationality2" value="<?=set_value('child_nationality2');?>">
	</div>
	<div class="large-4 columns"><span>&nbsp;</span></div>
	</div>
	
	<div class="clearfix"></div>
	<div  class="large-12 columns">
		<span>Residential Address in the Philippines</span>
		<?='<br>'.form_error('child_city_address');?>
		<input type="text" name="child_city_address" value="<?=set_value('child_city_address');?>">
	</div>
	<div class="clearfix"></div>
	<div class="large-4 columns">
		<span>Home Phone</span>
		<?='<br>'.form_error('child_telno');?>
		<input type="text" name="child_telno" value="<?=set_value('child_telno');?>">
	</div>
	<div class="large-4 columns">
		<span>Mobile Phone</span>
		<?='<br>'.form_error('mobile_phone');?>
		<input type="text" name="mobile_phone" value="<?=set_value('mobile_phone');?>">
	</div>
	<div class="large-4 columns">
		<span>Religion</span>
		<?='<br>'.form_error('child_religous');?>
		<input type="text" name="child_religous" value="<?=set_value('child_religous');?>">
	</div>
	<div class="clearfix"></div>
	
	<div class="large-12 columns">
		<span>1- The student will be living in the Philippines with (pls. check all that apply):</span>
		<?php
			if($cannot_be_with=='no'){echo'<br><span class="error_simple">Please choose at least 1.</span>';}
		?>
	</div>
	
	<div class="row">
		<div class="large-12 columns">
			<div class="large-4 columns">
				<?=form_checkbox('living_in_ph_with_father', 'yes', set_checkbox('living_in_ph_with_father', 'yes'));?>
				<span>Father / Step Father</span>
			</div>
			<div class="large-4 columns">
				<?=form_checkbox('living_in_ph_with_mother', 'yes', set_checkbox('living_in_ph_with_mother', 'yes'));?>
				<span>Mother / Step Mother</span>
			</div>
			<div class="large-4 columns">&nbsp;</div>
		</div>
	</div>
	
	<div class="row">
		<div class="large-12 columns">
		<div class="large-2 columns">
			<?=form_checkbox('living_in_ph_with_guardian', 'yes', set_checkbox('living_in_ph_with_guardian', 'yes'), 'id="living_in_ph_with_guardian"');?>
			<span>Guardian</span>
		</div>
		<div class="large-10 columns">&nbsp;</div>
		</div>
	</div>
	
	<div class="clearfix"></div>
	
	<div id="legal_guardian_info">
	<div class="large-12 columns">
		<span>Information about the legal guardian</span>
	</div>
	
	<div class="row" >
		<div class="large-12 columns">
			<div class="large-4 columns">
				<span>Guardian's First Name</span>
				<?='<br>'.form_error('guardian_name');?>
				<input type="text" name="guardian_name" value="<?=set_value('guardian_name');?>">
			</div>
			<div class="large-4 columns">
				<span>Guardian's Middle Name</span>
				<?='<br>'.form_error('guardian_mname');?>
				<input type="text" name="guardian_mname" value="<?=set_value('guardian_mname');?>">
			</div>
			<div class="large-4 columns">
				<span>Guardian's Last Name</span>
				<?='<br>'.form_error('guardian_lname');?>
				<input type="text" name="guardian_lname" value="<?=set_value('guardian_lname');?>">
			</div>
			<div class="clearfix"></div>
			<div class="large-4 columns">
				<span>Citizenship (Passport)</span>
				<?='<br>'.form_error('guardian_citizenship');?>
				<input type="text" name="guardian_citizenship" value="<?=set_value('guardian_citizenship');?>">
			</div>
			<div class="large-4 columns">
				<span>Philippine Visa Status</span>
				<?='<br>'.form_error('guardian_visa');?>
				<input type="text" name="guardian_visa" value="<?=set_value('guardian_visa');?>">
			</div>
			<div class="clearfix"></div>
			<div class="large-4 columns">
				<span>Employer or Organization</span>
				<?='<br>'.form_error('guardian_occup');?>
				<input type="text" name="guardian_occup" value="<?=set_value('guardian_occup');?>">
			</div>
			<div class="large-4 columns">
				<span>Office Phone Number</span>
				<?='<br>'.form_error('guardian_office_tel');?>
				<input type="text" name="guardian_office_tel" value="<?=set_value('guardian_office_tel');?>">
			</div>
			<div class="large-4 columns">
				<span>Mobile Number</span>
				<?='<br>'.form_error('guardian_contact_no');?>
				<input type="text" name="guardian_contact_no" value="<?=set_value('guardian_contact_no');?>">
			</div>
			<div class="clearfix"></div>
			<div class="large-12 columns">
				<label><?=form_checkbox('guardian_contact_no_text', 'yes', FALSE, set_checkbox('guardian_contact_no_text', 'yes'));?>&nbsp;<span>Would you like to receive text messages about upcoming events, activities and other school announcements on your mobile number?</span></label>
			</div>
		</div>
	</div>
	</div>
	
	<div class="large-12 columns">
		<div class="large-4 columns" style="padding:0px;">
			<span>2- Your child's English reading and writing level: </span>
			<?='<br>'.form_error('childs_english_reading_writing_level');?>
		</div>
		<div class="large-2 columns">
			<?=form_dropdown('childs_english_reading_writing_level', $chooseAttrib, set_value('childs_english_reading_writing_level'));?>
		</div>
		

		<div class="large-4 columns" style="padding:0px;">
			<span>3- Your child's English verbal proficiency: </span>
			<?='<br>'.form_error('childs_english_verbal_proficiency');?>
		</div>
		<div class="large-2 columns">
			<?=form_dropdown('childs_english_verbal_proficiency', $chooseAttrib, set_value('childs_english_verbal_proficiency'));?>
		</div>
		
	</div>
	
	<div class="large-12 columns">
		<span>4- Languages Spoken at home?</span>
		<?='<br>'.form_error('language_at_home');?>
		<input type="text" name="language_at_home" value="<?=set_value('language_at_home');?>">
	</div>
	
	<div class="large-12 columns">
		<span>5- List any participation in advanced level classes (i.e., Advanced Math, Gifted or Talented, Gateway, Writing, etc.)</span>
		<?='<br>'.form_error('participation_in_advanced_level_classes');?>
		<input type="text" name="participation_in_advanced_level_classes" value="<?=set_value('participation_in_advanced_level_classes');?>">
	</div>
	
	<div class="large-12 columns">
		<span>6- Did your child receive any remedial help in previous schools (i.e., Remedial Program, Special Education, Speech Therapy, IEP, IDP, etc). <br/>If yes, please explain and provide latest testing results.</span>
		<?='<br>'.form_error('remedial_help_in_previous_schools');?>
		<input type="text" name="remedial_help_in_previous_schools" value="<?=set_value('remedial_help_in_previous_schools');?>">
	</div>
	
	<div class="large-12 columns">
		<span>7- Does your child have any special talent or interest in:</span>
	</div>
	
	<div class="row">
		<div class="large-12 columns">
			<div class="large-2 columns">
				<?=form_checkbox('special_talent_interest_dance', 'yes');?>
				<span>Dance</span>
			</div>
			<div class="large-2 columns">
				<?=form_checkbox('special_talent_interest_drama', 'yes');?>
				<span>Drama</span>
			</div>
			<div class="large-2 columns">
				<?=form_checkbox('special_talent_interest_art', 'yes');?>
				<span>Art</span>
			</div>
			<div class="large-2 columns">
				<?=form_checkbox('special_talent_interest_acomputer', 'yes');?>
				<span>Computer</span>
			</div>
			<div class="large-3 columns">
				<?=form_checkbox('special_talent_interest_vocal_chorus', 'yes');?>
				<span>Vocal or Chorus</span>
			</div>
			<div class="large-1 columns">&nbsp;</div>
		</div>
	</div>
	<br>
	<div class="row">
		<div class="large-12 columns">
			<div class="large-4 columns">
				<?=form_checkbox('special_talent_interest_athletics', 'yes');?>
				<span>Athletics - favorite Sport(s):</span>
			</div>
			<div class="large-8 columns">
				<?='<br>'.form_error('special_talent_interest_athletics_spec');?>
				<input type="text" name="special_talent_interest_athletics_spec" value="<?=set_value('special_talent_interest_athletics_spec');?>">
			</div>
		</div>
	</div>
	<div class="row">
		<div class="large-12 columns">
			<div class="large-4 columns">
				<?=form_checkbox('special_talent_interest_band', 'yes');?>
				<span>Band (Instrument?)</span>
			</div>
			<div class="large-8 columns">
				<?='<br>'.form_error('special_talent_interest_band_spec');?>
				<input type="text" name="special_talent_interest_band_spec" value="<?=set_value('special_talent_interest_band_spec');?>">
			</div>
		</div>
	</div>
	<div class="row">
		<div class="large-12 columns">
			<div class="large-4 columns">
				<?=form_checkbox('special_talent_interest_string', 'yes');?>
				<span>String (Instrument?)</span>
			</div>
			<div class="large-8 columns">
				<?='<br>'.form_error('special_talent_interest_string_spec');?>
				<input type="text" name="special_talent_interest_string_spec" value="<?=set_value('special_talent_interest_string_spec');?>">
			</div>
		</div>
	</div>
	
	<div class="large-12 columns">
		<span>8- Is there any other information you think the teacher should know about your child?</span>
		<?='<br>'.form_error('hinder_childs_learning');?>
		<textarea name="hinder_childs_learning"><?=set_value('hinder_childs_learning');?></textarea>
	</div>
	
	<div class="large-12 columns">
		<span>9- Has your child ever been asked to leave school because of any behavioral / disciplinary problems? If yes, please explain.</span>
		<?='<br>'.form_error('leave_school');?>
		<textarea name="leave_school"><?=set_value('leave_school');?></textarea>
	</div>
	
	<div class="large-12 columns">
		<label class="span">Name of Previous School:</span> 
		<?='<br>'.form_error('previous_school');?>
		<input type="text" name="previous_school" value="<?=set_value('previous_school');?>">
	</div>
	<div class="large-12 columns">
		<label class="span">Complete School Address (including zip code):</span>
		<?='<br>'.form_error('previous_school_address');?>
		<input type="text" name="previous_school_address" value="<?=set_value('previous_school_address');?>">
	</div>
	<div class="large-12 columns">
		<span>Grade Level / Academic Year</span> 
		<?='<br>'.form_error('previous_grade_level');?>
		<input type="text" name="previous_grade_level" value="<?=set_value('previous_grade_level');?>">
	</div>
	
	<hr class="clearfix">
	<div>
		<input type="hidden" name="sdf_loc" value="<?=$token;?>">
		<input type="hidden" name="fillup_profile" value="true">
		<input type="submit" name="fillup_profile" id="submit_fillup_profile" value="Continue Part 2: Parent / Legal Guardian Information" class="btn btn-primary">
	</div>
<?php echo form_close(); ?>

</div>
<div class="large-1 columns">&nbsp;</div>
</div>
end old form ////*/ ?>

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